tbuckley/cabot-search huggingface dataset:
Abstract 15231: Relationship Between Severe Aortic Stenosis, Chronic Kidney Disease, and Clinical Outcomes in Patients With Aortic Stenosis
Authors: Muhammad R Uqaily, Samian Sulaiman, Kesavan Sankaramangalam, Dipesh Ludhwani, Irfan Zeb
Journal: Circulation (2022)

Introduction: Patients with chronic kidney disease (CKD) often have cardiovascular calcification with a higher prevalence of AV disease. Aortic valve calcium (AVC) scores are often used to assess the severity of aortic stenosis (AS). Methods: We retrospectively studied 361 patients with AS who underwent a CTA at our institute from Nov 2018 to Mar 2022. GFR values closest to the CTA, but at most three months prior, along with the occurrence of the following outcomes: TAVR, SAVR, and all-cause mortality were recorded. An AVC score &gt; 2000 for men and 1200 for women was defined as severe AS. Also, GFR values were split into 3 groups: &gt;=60 (Group 1), 30-59 (Group 2), and &lt;30 (Group 3). An interaction term (CKD x AS) was also used to evaluate the differential impact of severe AS on outcomes within the CKD groups. Results: There was no significant difference in AVC scores among the CKD groups (p = 0.21) using a Kruskal-Wallis test. However, severe AS was associated with a higher occurrence of outcomes (OR = 6.84 [1.67 - 27.96], p = 0.008*), along with a non-significant interaction term (OR = 0.63 [0.26 - 1.52], p = 0.3) using a logistic regression with severe AS, CKD groups, and the interaction term as independent variables. Moreover, using a cox proportional-hazards model with the same variables, severe AS had a significant association with the outcomes (HR = 2.51, p = 0.009*), with a non-significant interaction term (HR = 0.85, p = 0.43). Conclusions: There was no significant difference in AVC scores among the CKD groups. But irrespective of kidney function, severe AS was associated with worse outcomes. Therefore, similar thresholds of AVC scores can be used to define severe AS in patients with and without CKD.
Abstract 14645: Progression of Left Ventricular Ejection Fraction in Hospitalized COVID19 Patients With New Onset Cardiomyopathy
Authors: Sachin Kumar, Raunak Nair, Sarah Rikabi, Bindesh Ghimire, Grant W Reed, Umesh N Khot, Gautam Shah
Journal: Circulation (2022)

Introduction: New-onset cardiomyopathy (NOC) has been seen in hospitalized patients with COVID19 infection. Such NOC was associated with increased 30-day mortality. Long-term follow-up to assess the reversibility of such cardiomyopathy is lacking. We studied the follow-up echocardiograms in such patients and assessed the reversibility of their cardiomyopathy. Methods: We reviewed all cases of hospitalized COVID19 patients from the Cleveland Clinic COVID19 registry from 18 th March, 2020 to 18 th May, 2021. Patients who received an in-hospital echocardiogram and had echocardiogram prior to and post COVID19 hospitalization were selected for the study. NOC was defined as a reduction in left ventricular ejection fraction (LVEF) of &gt; 10% with a new LVEF of &lt; 53%. Cardiomyopathy was considered reversible if the follow-up echocardiogram showed an improvement in LVEF, with new LVEF &gt;53%. The mean interval between the in-hospital and follow-up echocardiogram was 5.6 months. Results: Of the 1537 hospitalized COVID19 patients receiving echocardiogram, 907 had a prior echocardiogram, of which 77 (8.5%) had NOC. Patients with NOC were significantly more likely to be females and have chronic kidney disease. Of the 77 patients with NOC, 35 (45.5%) had follow-up echocardiograms. Of these, only 13 (37.1%) had reversible cardiomyopathy while 22 (62.9%) had persistently decreased LVEF. Conclusions: Our study highlights the lack of follow-up echocardiograms for patients with NOC and a persistence in decreased left ventricular systolic function in those that received one. All patients with NOC and COVID19 infection should receive follow-up echocardiography to guide their management.
Abstract 14599: Survival From Sudden Cardiac Arrest During the COVID-19 Pandemic: Two-Year Prospective Evaluation in a Large US Community
Authors: Harpriya Chugh, Arayik S Sargsyan, Kotoka Nakamura, Audrey Uy-Evanado, Daniel Shepherd, Angelo Salvucci, Sumeet S Chugh, Kyndaron Reinier
Journal: Circulation (2022)

Background: Early experience in the COVID-19 pandemic indicated higher rates of out-of-hospital sudden cardiac arrest (SCA) and worse outcomes. There is little data from subsequent surges of Delta and Omicron variants. Hypothesis: All surges in the COVID-19 pandemic affected SCA incidence and outcomes. Methods: In Ventura County CA (pop. 848,112), all SCA cases with likely cardiac etiology and resuscitation attempted by emergency medical services (EMS) were prospectively identified (2015-). Comparisons were conducted between two years of the pandemic period (Feb 1, 2020-Jan 31, 2022) and the corresponding 2y pre-pandemic period (2018-2020) and during COVID surges (&gt;3000 COVID cases / month in the county) vs. non-surge times during the pandemic (&lt;3000 cases / month). COVID monthly incidence was obtained from US CDC data (Fig. red curve). Results: Pre-pandemic there were 671 SCA cases (40/100,000, mean age 70.9 yrs, 63% male) with an increase in the pandemic period (p&lt;0.001) to 894 cases (53/100,000, mean age 69.6 yrs, 65% male). During the pandemic there was significant reduction in SCA survival (16.4% to 9.1%, p &lt;0.001). Survival decreased consistently with each COVID surge. The mean SCA survival during surges (Fig. blue curve) was significantly lower than pre-pandemic (6.3% vs 16.4% dotted blue curve, p &lt;0.001) as well as during non-surge periods (6.3% vs 11.4%, p=0.008). Comparing pre-pandemic to COVID surge periods, the proportion of SCA calls with ambulance response time &lt; 4 min declined from 27.1% to 9.4% (p&lt;0.001) as did the proportion of SCAs with shockable rhythm (26.2% to 18.6%, p=0.004), and bystander CPR (56.9% to 47.9%, p=0.004). Conclusion: SCA rates continue to be higher during the COVID-19 pandemic with persisting significant reductions in survival outcomes at 2y, that are exaggerated during each surge. These findings have implications for ongoing community public health and EMS response planning during the pandemic.
Abstract 255: Association Of Hospital Market Area Dominance With Out-of-hospital Cardiac Arrest Survival To Admission
Authors: David G Buckler, Ethan Abbott, Brendan G Carr, Douglas Wiebe, Alexis Zebrowski
Journal: Circulation (2022)

Introduction: Access to care has been measured by geographic distance, transport time or provider density. For emergency care sensitive conditions, like out-of-hospital cardiac arrest (OHCA), market area coverage may be associated with short-term outcomes due to the need for access to definitive care. Our objective was to evaluate the association of market area dominance with survival to hospital admission. Methods: ED-treated OHCA were identified in age-eligible Medicare fee-for service claims using ICD 9/10 codes and ED charges. Hospital market shares were defined as the cumulative proportion of all OHCA claims treated at the hospital of interest within a group of ZIP code tabulation areas (ZCTAs) centered around the hospital. Market share was calculated using sequential addition of ZCTAs. Hospital Market Areas (HMAs) included all ZCTAs where the cumulative market share exceeded a threshold (&lt;50% 50-74% 75-89% ≥90%). Survival to admission was determined using in-patient claims and vital status data. The primary predictor, maximum HMA threshold, is the highest market share proportion covering that ZCTA. A ZCTA with a 90% max HMA has one hospital treating 90% of OHCA case in that ZCTA or closer. Relative risk of survival was calculated using modified Poisson regression with hospital random effect and patient characteristics (age, sex, race, comorbidity). Results: Of the 194,914 claims treated at 4,436 hospitals between 2013 and 2015, 45% were female, 16% Black, 77% White, and 50% from large metro areas. 28% of claims were from a ZCTA with &lt;50% max HMA (an area where no single hospital treats the majority of OHCA). Relative risk of survival to admission decreased as the max HMA increased [RR[95%CI] 50-74%: 0.97[0.95, 0.99]; 75-89%: 0.94 [0.91, 0.98]; ≥90%: 0.90 [0.83, 0.98]. Small and non-metro areas were associated with lower survival likelihood. Interactions were not significant between max HMA and small metro areas; non-metro areas saw a greater reduction in survival likelihood for ZCTAs with max HMAs &gt;75%. Conclusion: For OHCA, market dominance was associated with lower likelihood of survival to hospital admission. The likelihood of survival decreased as market dominance increased. Further study is needed to develop strategies to mitigate this disparity.
Abstract 15766: A Perfect [vt] Storm - How All the Wrong Factors Converged During a Dofetilide Load
Authors: Nathaniel McConkey, Ravi Shah, Marcin Kuzma, Justin Rackley, Mario Gonzalez
Journal: Circulation (2022)

Background: Dofetilide is a class III antiarrhythmic often used for the treatment of atrial fibrillation. Given its QTc prolonging properties, it is invariably initiated in an inpatient setting. While admissions for this drug are often unexciting, pharmacologic cardioversion in general and dofetilide in particular carry unique hazards. Objective: To review a case where several risk factors converged during a dofetilide load to produce a life threatening event. Case: A 75 year old male in persistent atrial fibrillation was admitted for dofetilide and started on 500 mcg PO Q12 (based on QTc and GFR). He did not experience any QTc prolongation after his first two doses, and converted to sinus rhythm on his second day of hospitalization. With this, he had an abrupt decrease in heart rate from 110 to 60 bpm. Within minutes, he suddenly developed flash pulmonary edema and required treatment for acute heart failure with IV diuresis. Fortunately, he improved with therapy in time to receive his third dose, after which QTc remained at 450. However, he had non sustained polymorphic ventricular ectopy overnight. His full AM dose was given before the monitor was reviewed (given his normal QTc), and within 2 hrs of this fourth dose, QTc prolonged markedly. He developed ventricular bigeminy with long-coupled PVCs. Subsequently, he developed sustained torsades requiring chest compressions and defibrillation. The patient recovered well, and dofetilide was discontinued. Conclusion: Acute heart failure after restoration of sinus rhythm is an uncommon but known complication of cardioversion, both electrical and pharmacologic. Furthermore, hemodynamic derangement is known to decrease arrhythmia threshold, which, along with his abrupt drop in heart rate and recent diuresis, likely contributed to the development of torsades. Furthermore, while his QTc appeared numerically acceptable before the fourth dose was given, later review revealed an abnormal T wave morphology with prolonged T peak to end time, which might have prompted a dose change if recognized. In short, monitoring dofetilide patients involves more than just GFR and QTc - other observable factors can portend poor outcome.
Abstract 15445: Combination Therapy With Pde5-mtor Inhibitors Attenuates Cardiotoxicity While Enhancing Cancer Cell Death Following Treatment With Doxorubicin and Human Epidermal Growth Factor Receptor 2 Inhibitor
Authors: Anindita Das, Donatas Kraskauskas, Nuhash Bhuiyan, Arun Samidurai, Rakesh C Kukreja
Journal: Circulation (2022)

Backgound: Chemoimmunotherapy with Doxorubicin (DOX) and Trastuzumab (Trast, a monoclonal antibody against human epidermal growth factor receptor 2, ERBB2) has synergistic effects with immense improvement in disease-free survival in breast cancer patients. However, because of the high incidence of heart failure, the concomitant treatment with DOX and trastuzumab has been restricted. In the present study, we examined whether a novel combination therapy with the phosphodiesterase 5 (PDE5) inhibitor (sildenafil, Sild) and mTOR inhibitor (rapamycin, Rapa) can attenuate cardiotoxicity-induced by DOX+Trast. Methods &amp; Results: Human ventricular cardiomyocytes (AC16) and ErbB2 + breast cancer cells (SKBr3) were treated with DOX (1μM), AG-825 (ERBB2 inhibitor, 5μM) and/or Sild (10μM) and Rapa (100 nM) for 24 hours. AC16 cell death was significantly higher with DOX+AG825 as compared to the single drug treatment, which was significantly reduced with Sild+Rapa treatment (Fig. A ). Contrarily, the enhanced SKBr3 cell death with DOX+AG825 treatment was further increased by Sild+Rapa treatment (Fig. B ). To evaluate therapeutic effect of Sild+Rapa against cardiotoxicity, C57BL/6J mice were treated for 2 weeks with DOX (6 mg/kg/twice/week, i.p.). After 1week interval, mice were treated with Trast for 2 weeks (2.5 mg/kg/twice/week, i.p.) (Fig. C ). Rapa (0.25 mg/kg/twice/week, i.p.) and Sild (0.4 mg/ml in drinking water) were administered for 12 weeks. Body weight, left ventricular ejection fraction (LVEF) and E/A ratio as well as survival were significantly decreased in mice with the sequential treatment of DOX and Trast as compared to DOX alone (Fig. D-G ). Treatment with Sild+Rapa significantly improved body weight and survival with restoration of cardiac function in mice treated with DOX±Trast. Conclusion: Combination treatment with Sild and Rapa could be a novel strategy to attenuate cardiotoxicity associated with DOX±Trast and improvement of cancer chemotherapy.
Abstract 14609: Exposure to Any Hospitalization and Specific Invasive Procedures Post Open Heart Valve Surgery Increases the Risk of Endocarditis
Authors: Timothy N Kwan, Vincent Chow, David Brieger, Raymond Sy, Leonard Kritharides, Austin Ng
Journal: Circulation (2022)

Introduction: Infective endocarditis (IE) after cardiac valve surgery is associated with high morbidity and mortality. Nosocomial exposure is a growing cause of IE in general. We investigated the risk of post valve surgery endocarditis (PVE) in patient who had any hospitalization and specific nosocomial exposures after open heart valve surgery. Methods: We identified all ≥18yo patients who had their first open heart cardiac valve surgery between 2001-2017 in New South Wales, Australia from the Admitted Patient Data Collection (APDC) registry. Patients with prior/current IE diagnosis at time of index valve surgery were excluded. Follow up was until 31 Dec 2018 with mortality and morbidity tracked from the respective death and APDC registries. Analyses based on Cox regression modelling included age, sex, background diagnoses and features of index valve surgery as time independent covariates, with any hospitalization (separately for specific invasive procedures) post index valve surgery as time dependent exposure covariates for risk of PVE within 6 months of exposure. Results: In total 23747 patients (median age [IQR] 73yo [65-79yo, 63% male) had cardiac valve surgery: 60% isolated aortic valve (n=15065), 28% isolated mitral valve (n=6702), 10% multiple valves (n=2385) and 1.5% right sided valves (n=357). 5.4% (n=1293) of patients experienced PVE at a median 2.9 years (IQR 0.7-6.2) after index valve surgery, with 65% (n=838) occurring within 6 months of any hospitalization. Any hospitalization exposure was associated with an adjusted hazard ratio of 4.0 for developing PVE (95% confidence interval 3.5-4.5). In addition, specific invasive procedures including repeat valve surgery were associated with an elevated risk for PVE (Figure). Conclusions: PVE is significantly more common after any hospitalization with specific invasive procedures carrying differential risk. Care should be taken to avoid unnecessary hospitalizations and procedures in these patients.
Abstract 15795: Connections Between the Western Diet and Inflammation in Heart Failure
Authors: Erica Davis, Sandra B Dunbar, Melinda Higgins, Kathryn A Wood, Alanna A Morris, Brittany Butts
Journal: Circulation (2022)

Introduction: The Western Diet (WD) is associated with deleterious processes linked with chronic disease and may play a role in the pathophysiology of heart failure (HF). Trimethylamine-N-oxide (TMAO) is a diet-linked metabolite that contributes to inflammation and is associated with higher TNF-α, especially in HF populations. The dietary inflammatory index (DII) score measures the inflammatory potential of a diet and the inflammatory effects of foods. More studies are needed to determine how the WD impacts immunological pathways and cytokines in the context of clinical and population characteristics. Purpose: The aim of this study was to explore associations between the WD, DII, TMAO, and TNF-α in Black patients living with HF. Methods: Thirty Black participants (mean age 55.3, 67.7% women) with HF were included in this study. TMAO and TNF-α levels were analyzed from dried blood spots using immunoassays. Participants completed a Food Frequency Questionnaire (FFQ) from which a DII score was derived. Food groups and nutrients, like choline, were measured with the FFQ. Sociodemographic variables were measured. Analyses included correlational and inferential statistics. Results: Mean DII score was -.38 revealing an overall anti-inflammatory diet with higher inflammatory scores among men (-.23) as compared to women (-.43). Women consumed greater kilocalories with more saturated fat, sodium, dairy, sugar, and fruit while men consumed more cholesterol, choline, proteins, alcohol, legumes, poultry, red meats, eggs, and phosphatidylcholine. DII score was negatively correlated with dietary choline (r= -.73, p&lt;.001), but did not correlate with TMAO or TNF-α. TNF-α and TMAO were positively related (r=.30, p=.057). Conclusions: This sample of well-educated HF patients from a busy HF referral center did not consume a highly pro-inflammatory diet, yet our findings provide insight for specific food groups such as those with choline. In patients with HF, it is important to monitor intake of inflammatory foods and appreciate that increasing age may play a role in the retention of dietary metabolites. Further study of these relationships in patients with HF could lead to tailored dietary educational interventions based on dietary patterns, age, and cultural relevance.
Abstract 15793: Gender-Specific Pathophysiologic Differences in All-Cause Mortality Among Patients With Atrial Fibrillation
Authors: Sidhartha Senapati, Hon-chi Lee, Jae K Oh, Eddie L Greene, Rowlens M Melduni
Journal: Circulation (2022)

Introduction: Although the prevalence of atrial fibrillation (AF) is higher in men than in women, the onset of AF appears to diminish the survival advantage in women. The pathophysiologic factors underlying survival outcome in AF are not well understood. Methods: A cohort of 3480 Olmsted County, Minnesota residents (mean age 72.8±14 years, 51.8% female) with incident AF who underwent transthoracic echocardiography within 30 days of AF diagnosis [median (IQR) 1, 1-6 days] were retrospectively studied. We examined the association of clinical parameters and survival according to gender. Kaplan-Meier and Cox proportional hazards models were used to compare overall survival in males and females. Results: Females were older and slimmer than males and more frequently had hypertension, prior stroke, and had higher CHA 2 DS 2 vasc score, pulse pressure and effective arterial elastance. Women also had smaller LV end diastolic dimension with higher LV ejection fraction, LA volume index, E/e prime ratio, and PASP (43.6±13.8 vs 39.1±13.3; &lt;.001). During a mean follow-up of 7.4±6.2 years (median 6.6 years), 2569 patients died. Women had a lower 5-year survival compared to men. The probability of 1- and 5-year survival rates for women vs men were 80.2% vs 84.1% at 1 year and 54.4% vs 63.7% at 5 years (log-rank P &lt;.001). In multivariable Cox regression analysis, after accounting for potential confounders, the independent predictors of mortality were age (HR 1.07 [95% CI 1.06-1.08]), PASP (per 5 unit increment) (HR 1.11 [95% CI 1.09-1.12]), effective arterial elastance (HR 1.06 [95% CI 1.01-1.12]), previous heart failure (HR 1.34 [95% CI 1.20-1.49]), diabetes (HR 1.33 [95% CI 1.20-1.48]), prior stroke (HR 1.26 [95% CI 1.13-1.41]), smoking (HR 1.13 [95% CI 1.06-1.20]), chronic lung disease (HR 1.32 [95% CI 1.20-1.45]), peripheral arterial disease (HR, 1.32 [95% CI 1.18-1.48]), and chronic kidney disease (HR, 1.52 [95% CI 1.38-1.69]). Conclusions: In a community-based cohort of patients with incident AF, markers of arterial stiffness and diastolic dysfunction were more prevalent in women compared to men and were strongly predictive of mortality. Our findings suggest that vascular stiffness may underlie the increased risk of mortality observed in women after a new diagnosis of AF.
Abstract 14703: Short Term Safety and Efficacy of Escalating Doses of Atorvastatin for Dyslipidemia in Children With Predialysis Chronic Kidney Disease Stage 2-5
Authors: Punitha L Ramesh, Priyanka Khandelwal, Aditi Sinha, Lakshmy R, Pankaj Hari, Arvind Bagga
Journal: Circulation (2022)

Introduction: Dyslipidemia is a potentially modifiable risk factor in patients with chronic kidney disease (CKD). Information on safety and efficacy of statins in pediatric CKD is limited. Methods: Patients with CKD stage 2-5, aged 5- 18 years with low density lipoprotein cholesterol (LDL-C) &gt;130mg/dL and/or non-high density lipoprotein cholesterol (non HDL-C) &gt;145mg/dL were enrolled from September 2019 to February 2021. All patients were administered atorvastatin 10 mg/day, and escalated to 20 mg/day if LDL-C&gt;100 mg/dL and/or non-HDL &gt;120mg/dL at 12 weeks. Proportion of patients achieving target lipid levels (LDL-C ≤100 mg/dL and non HDL-C ≤120mg/dL), change in lipid and adverse effects were assessed at 24 weeks. Wilcoxon sign rank test was used to assess percentage change in lipid. Results: Of the 31 patients enrolled, target lipid levels were achieved in 45.2% patients (95% CI 27.8%-63.7%) at 24-week; 22 patients required dose escalation to 20 mg at 12 weeks. There was no difference in median reduction in lipid levels with 10 mg/day (n=9) versus 20 mg/day (n=22; p=0.3). Higher baseline LDL-C (OR 1.06, 95% CI 1.00 to 1.11) and older age (OR 36.50 95% CI 2.57 to 519.14) were independent predictors of failure to achieve target lipid levels with 10 mg/day atorvastatin. None had persistent rise in AST/ALT &gt;3 times upper normal limit (UNL) or CPK &gt;10 times UNL. No differences were noted in the adverse effects of atorvastatin 10 mg/day and 20 mg/day. Conclusions: Atorvastatin (10-20 mg/day) administered for 24 weeks was safe and effectively reduced LDL-C and non HDL-C in children with CKD stage 2-5. Patients with higher baseline LDL-C required higher doses to achieve the target.